St. Luke's Health Beat Fall 2013

Fall 2013

St. Luke’s

B E A T 

Student learns an important lesson Misstep leads to broken ankle PAGE 6

Heart disease under 40

A young survivor shares his story PAGE 2

Keeping families close to home NICU care expands across eastern Iowa PAGE 4

New treatment for prostate cancer

Drug prolongs and improves quality of life PAGE 8

unitypoint.org/cedarrapids

What’s

Inside 1

Health Clips

Health news you can use.

2 - 3 A young survivor’s story

A Cedar Rapids man’s heart attack prompts those close to him to make lifestyle changes.

8-9 4-5

4 - 5 Improving newborn intensive care across eastern Iowa

St. Luke’s expands its network of care to keep families closer to home.

2-3

12

6 - 7 Student learns important lesson A college student recovers from a 8 - 9 New treatment for prostate cancer A newly approved drug offered only at St. Luke’s gives hope to men with advanced prostate cancer.

10 - 11 Choosing UnityPoint Hospice

A hospice nurse becomes a patient after receiving a life-limiting diagnosis.

12

Ask the Expert

What new technologies are available for breast cancer treatment?

13

For your health

Missed

On the

broken ankle after falling on snow and ice.

10

cover

the last issue?

Jeralyn Westercamp is getting around campus a little easier after recovering from a broken ankle.

Stories from Health Beat, Spring 2013, are available at unitypoint.org/cedarrapids

ealth H St. Luke’s

B E A T

Health Beat magazine is produced locally by St. Luke’s Marketing Communications for the community and friends of St. Luke’s Hospital.



Vol. 18 No. 3 l Fall 2013

P.O. Box 3026 l Cedar Rapids, IA 52406-3026 319/369-7395 l unitypoint.org/cedarrapids

2013

Timely health and medical news.

Connect with St. Luke’s at unitypoint.org/cedarrapids

Health Clips

Coventry Health Care Expands Partnership with UnityPoint Health Coventry Health Care and UnityPoint Health recently announced the expansion of their partnership to provide high-performance network plans in the state of Iowa.

Coventry’s “Carelink” high-performance network plans will give more Iowans affordable access to care through the clinics, hospitals and home care services of UnityPoint Health – the nation’s fourth largest nondenominational health system.

Bill Leaver, president and CEO of UnityPoint Health, said “At UnityPoint Health, we coordinate care between the doctor, the hospital and care at home – making sure our patients receive the most focused and effective care possible. Coventry’s high-performance network model complements our approach to patient care well. Our collaboration helps bring both quality care and lower premiums across a larger part of Iowa.”

Updates and more information about the Coventry Health Care and UnityPoint Health partnership, including upcoming free educational programs, can be found at unitypoint.org/cedarrapids under the classes and events tab.

St. Luke’s earns a Blue Zones Worksite™ designation St. Luke’s Hospital has been named a designated Blue Zones Worksite™.

More than 850 hospital employees took the Blue Zones® personal pledge to push the hospital over the finish line and achieve the workplace designation.

“We are honored and excited to be one of the first workplaces in Cedar Rapids to receive this designation,” said Ted Townsend, St. Luke’s president & CEO. “As a healthcare organization the mission of the Blue Zones Project™ aligned perfectly with our mission, values and beliefs. This designation will just give us more goals to work towards as we improve not only our patient’s health but our own.”

The Blue Zones Project is based on the principles researched by New York Times Best-Selling Author Dan Buettner. The term Blue Zones represents regions on Earth where people live longer, better lives through principles that include moving naturally, having the right outlook, eating wisely and having a sense of belonging.

Overall these communities create an environment, that makes it easier to make healthy choices.

Learn more at bluezonesproject.com.

UnityPoint Health – St. Luke’s Hospital among the best in Iowa St. Luke’s Hospital is among the nation’s Best Regional Hospitals, according to U.S. News and World Report. St. Luke’s is ranked second in Iowa and is recognized as one of America’s high-performing hospitals in six specialties in the U.S. News & World Report 2013-14 edition.

St. Luke’s ranked high-performing in six specialty areas: • Cardiology & Heart Surgery • Gastroenterology and GI Surgery • Geriatrics

• Orthopedics • Pulmonology • Urology

U.S. News evaluates hospitals in 16 adult specialties. In most specialties, it ranks the nation’s top 50 hospitals and recognizes other high-performing hospitals that provide care at nearly the level of their nationally ranked peers.

St. Luke’s Health Beat | Fall 2013 |

1

Matt Kolsrud and sister, Kristin Biedermann, ride their bikes along the trail in downtown Cedar Rapids.

Heart attack prompts others to make changes

M

att Kolsrud wants to see his son, Paul, and daughter, Adrianna, graduate from high school and college. He hopes to someday walk his daughter down the aisle at her wedding. These are goals most parents have but both were in danger last spring when he suffered a heart attack. He’s 38.

“I started feeling the sensation you have when it’s really cold outside and you take a deep breath and it feels like your lungs are frosted,” said Kolsrud. “I had it on and off for about a week. I thought I had walking pneumonia or bronchitis.

I decided to get it checked out.”

He went to Urgent Care where an EKG indicated his heart was in distress.

“I wasn’t expecting it to be heart-related so that was a big surprise,” said Kolsrud.

“I was sent to the ER for further testing.

I called my wife, Mandie, on the way and of course, she was concerned.”

Also concerned was Matt’s sister, Kristin Biedermann. She received a call from Mandie, who told her “not to panic” but that Matt was at UnityPoint Health – St. Luke’s Hospital.

“How do you not panic?” asked Biedermann. “Never do you expect to hear your 38-year-old brother is in the ER with a heart issue.”

2 | unitypoint.org/cedarrapids

A young survivor’s story Heart blockages Kolsrud had a heart catheterization procedure, which determined he had several serious blockages and needed open-heart surgery.

“Honestly I was freaking out,” said Kolsrud. “Here I am 38 and they are going to crack my chest open. Images of my family, my kids and major life moments I wanted to be a part of started flooding through my head. How was this happening to me?”

“The burning sensation Matt had in his chest is not an unusual heart attack symptom especially if it’s brought on by stress or exertion and if it goes away when you rest – that becomes more suspicious,” said Keith Kopec, MD, UnityPoint Clinic Cardiology. “Matt had a small heart attack, which was detectable by blood tests. Fortunately he caught it before it could do any significant damage.”

“We work closely with the cardiologists to make decisions about surgery for every patient,” said James Levett, MD, Physicians’ Clinic of Iowa cardiothoracic surgeon.

“Younger patients are not ones we want to take into the operating room without good reason. That collaboration between the surgeons and cardiologists is important and helps us make decisions in the best interest of the patient.”

Setting standards On March 14 Kolsrud had quadruple heart bypass surgery, performed by Dr. Levett. He spent eight days at St. Luke’s.

“St. Luke’s follows national guidelines in using the internal mammary artery because they tend to stay open longer,” said Dr. Levett. “What sets St. Luke’s apart from other hospitals nationwide is their additional use of the radial artery because they last longer than vein grafts. This will give Matt an advantage and hopefully delay the need for additional surgery in years to come.”

Monthly care conferences held at St. Luke’s among heart care team members also benefit patients like Kolsrud. A team of healthcare professionals collaborate and constantly look for ways to improve care.

“Everyone was really great at St. Luke’s,” said Kolsrud. “I knew I was at the right place because it’s a Top 50 Heart Hospital – they are the heart experts. I participated in cardiac rehabilitation after my surgery.

Ironically about six months before my heart attack my wife and I were making efforts to eat better. This surgery made it even more important and cardiac rehab

educated us on how to make better food choices.”

Inspiring others “It’s inspiring to see the changes Matt is making in his life,” said Biedermann.

“Overall it was an emotionally surreal experience. His heart attack reminded me that no one is invincible. At 34, I am only slightly younger than Matt but we share the same genes. So it forced me to evaluate my own health. What I eat, how much I exercise. I took this as a wake-up call and sought to control the things I could.”

Biedermann made an appointment with her brother’s cardiologist who did a complete work-up, which included a Heart Scan and is working with him to help her become more heart healthy.

“Discovering the extra heart-healthy foods has been my focus,” said Biedermann. “I wasn’t a candidate to cut out soda or Twinkies because those have never been a part of my lifestyle, so I had to get creative. I wanted to model healthy behavior for my daughters and instill healthy eating habits so hopefully it becomes second nature for them. We are also finding more ways to exercise as a family.”

$99 Heart Scan St. Luke’s Heart Scan identifies calcified plaque in your coronary arteries and assesses your heart’s health. There are no injections, treadmills or pre-test fasting.

All that is needed is your doctor’s referral.

Call 319/369-8909 for St. Luke’s $99 Heart Scan.

attack, especially when it’s someone as young as Matt, gets everyone’s attention.

If an individual has high cholesterol, other risk factors and has a parent or sibling that suffered a heart attack at an early age, it’s good to be proactive.”

Kolsrud continues his weight loss with healthy eating. He makes it a goal to walk, run or bike at least five miles a day. His sister, Kristin, has lowered her cholesterol 25 percent and lost weight as a result of her stepped-up efforts.

“I am more proactive with my health,” said Kolsrud. “I want to be around for a long time. Something told me to go to the doctor that day and I’m glad I trusted my gut. It saved my life.”

“I am seeing more individuals like Kristin, in their 30s and 40s with a family history of heart disease,” said Dr. Kopec. “A heart

“That collaboration between the surgeons and cardiologists is important and helps us make decisions in the best interest of the patient.”

Keith Kopec, MD, UnityPoint Clinic Cardiology

James Levett, MD, Physicians’ Clinic of Iowa cardiothoracic surgeon

St. St.Luke’s Luke’sHealth HealthBeat Beat | | Fall Fall2013 2013 | |

3

Improving newborn intensive care

across eastern Iowa

P

regnancy was a breeze for Amber Becker of Cedar Falls. Everything went as expected. She didn’t even have a bit of morning sickness to contend with. Becker had the vision of a perfect birthday for her son, Joseph.

“As planned, we arrived at Waverly Health Center to deliver,” said Becker. “I was in labor for about 20 hours and Joseph’s heart rate started decelerating so I had an emergency C-section. He was actually born on his due date, which was May 2.”

Joseph’s birthday was far from perfect.

Doctors rushed to his side and started chest compressions. He was having difficulty breathing.

“It was scary,” recalled Becker. “We were told he needed critical care. A short time later it was recommended he be transferred to St. Luke’s Newborn Intensive Care Unit (NICU). I was also transferred there several hours later. I was grateful to be going with him to Cedar Rapids.”

Outreach NICU Pankaj Nagaraj, MD, is the NICU medical director at UnityPoint Health – Allen Hospital in Waterloo. He is also a member of UnityPoint Health – St. Luke’s Hospital’s NICU team. Allen’s 9-bed, Level II NICU cares for babies in Waterloo, Waverly and surrounding areas as far north as New Hampton and West Union.

“From Dr. Nagaraj’s point of view, being part of St. Luke’s NICU team allows him to be part of a bigger group,” explained Dennis Rosenblum, MD, St. Luke’s NICU neonatologist. “He participates in our meetings, standards of care, policies and at the same time, we can set up a better system for coverage when he’s gone. It’s consistent and continuous.”

As part of his role with Allen and St. Luke’s, Dr. Nagaraj received a call from the staff at Waverly when Joseph was born. After evaluating Joseph’s clinical condition at the Waverly hospital, he recommended Joseph’s transfer to St. Luke’s where he could receive more specialized care.

“In the past, some sicker babies born before 34 – 36 weeks were transferred to Iowa City,” said Dr. Nagaraj. “But now most babies born over 30 weeks are staying in the Allen NICU. Parents really see the benefits because they’re able to stay with their babies closer to home. There are some instances, such as the case with Joseph, where they need more critical and specialized care and that’s when we’ll transfer them to St. Luke’s with the intent to move them back to Allen as soon as they are medically stable.”

Critical care for babies St. Luke’s is the only Advanced Level II Regional NICU and Neonatology Center in the Cedar Rapids area. Other hospitals – like Waverly Health Center, transfer newborns to St. Luke’s when they need specialized care. Cedar Rapids tiniest baby ever born – at just 13 ounces – was born at St. Luke’s. Hospital staff has cared for over 9,000 babies. St. Luke’s NICU team

“ Parents really see the benefits because they’re able to stay with their babies closer to home.”

Pankaj Nagaraj, MD, Allen Hospital NICU medical director and St. Luke’s NICU neonatologist

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includes neonatologists, neonatal nurse practitioners, nurses and respiratory therapists, all of whom are specially trained to provide critical care for babies.

“Once I was settled in my room at St. Luke’s my husband, Michael, took me to the NICU to see our son for the first time,” said Becker.

“It was difficult. He looked terrible and had all of these tubes hooked up to him. We were told he had aspirated on meconium and was having difficulty breathing.”

Meconium aspiration can happen before, during or after labor and delivery when a newborn inhales a mixture of meconium and amniotic fluid. Meconium is the baby’s first feces, which is sticky, thick and typically passed in the womb during early pregnancy and again in the first few days after birth. The inhaled meconium can partially or completely block a baby’s airway.

care at St. Luke’s. But the more we thought about it we realized it would ease the burden on my husband who was driving from Cedar Falls to Cedar Rapids daily.

It was nice to get closer to home.”

transition smooth and eased any fears or concerns we had. After several weeks in both NICUs Joseph was sent home. Today he’s a healthy and happy five month old.

Team effort

“My experience with St. Luke’s and Allen was unbelievable,” said Becker.

“I think the doctors and nurses take the care they give to a personal level and really love their patients. You can tell they really want what is best for them and want to help them. I would definitely recommend them to anyone.”

The success of St. Luke’s NICU outreach model at Allen is now being embraced by UnityPoint Health –Trinity Health System in Bettendorf and Moline, IL. “We try to keep the babies and moms in their home communities when possible,” said Dr. Rosenblum. “It’s a total team effort.

We believe it is the right thing to do for the baby and the parents.”

We invite you to learn more about St. Luke’s Birth Care and NICU at unitypoint.org/babies.

“When we transferred to Allen it was nice to know it was all the same people caring for Joseph,” said Becker. “It made the

“The team at St. Luke’s was so great about explaining everything they were doing for Joseph,” said Becker. “The care at St. Luke’s was amazing. From the time I was admitted they were sensitive to the fact that my baby was in the NICU and I had just had a C-section. They helped me go see my baby whenever I wanted. The nurses were fabulous in both Birth Care and the NICU. I can’t say enough good things about them.

I never realized Allen and St. Luke’s worked with other smaller hospitals to take care of sick babies. I’m so glad they do.”

After two weeks at St. Luke’s NICU, the team talked with the Beckers about transferring Joseph to Allen Hospital in Waterloo.

“We really liked the care Joseph was getting at St. Luke’s,” said Becker. “So when they mentioned sending him to Allen’s NICU so he could be closer to home we were a little hesitant because he was getting such great Michael and Amber Becker are grateful for their son, Joseph, who is healthy, happy and keeps his parents up at night with typical teething woes.

St. Luke’s Health Beat | Fall 2013 | 5

Student learns important lesson Misstep leads to broken ankle

Y

ou can bet the next time Jeralyn Westercamp goes outside “just for a couple of minutes” in the middle of winter – she’ll take the extra time to put snow boots on.

“I had just come home from all day classes at the University of Iowa,” recalled Jeralyn.

“I thought I would take a quick trip outside, walk the dogs and fill the bird feeder.”

It was a cold day. Cedar Rapids recorded a high of three degrees around 6 p.m. on January 31, 2013. With the wind chill it felt more like 20 below zero. The National Weather Service had issued a wind chill advisory that day.

“It was very cold,” said Jeralyn. “All I remember is one minute I am walking the dogs and the next minute I am down on the ground. It didn’t initially hurt but I couldn’t put weight on my right leg. I noticed it was at a bad angle and I heard a pop. I tried to get up but couldn’t. At first I thought my whole leg was broken.”

Jeralyn had been wearing flats but no socks. The slick shoes, combined with snow and ice on the ground caused her fall. Thankfully she was wearing a coat and fished gloves out of her pockets. Her cell phone had been left inside the house.

No one else was home. Both of her parents were away at meetings.

“I knew I had to do something,” recalled Jeralyn. “Our house isn’t in a busy area so the chances of someone finding me were remote. I knew I had to get inside and call for help. I couldn’t stay outside and wait.

It was too cold.”

Jeralyn managed to crawl back to the house. She was able to drag herself up the steps and open the door.

Jeralyn Westercamp no longer takes walking across the University of Iowa campus for granted after she was sidelined by a broken ankle.

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“I called my parents and reached my Dad who rushed home to help me,” said Jeralyn.

“We went to a doctor where it was determined my ankle was broken and surgery was needed the following morning.”

“ We’ve worked with a collaborative team of health professionals, which include therapy and physiatry to help her fully recover.”

Sandeep Munjal, MD, Physicians’ Clinic of Iowa orthopedic surgeon

Frost bite damage “When I first saw Jeralyn’s ankle I was surprised with the amount of blisters I saw,” said Sandeep Munjal, MD, Physicians’ Clinic of Iowa orthopedic surgeon. “The blisters were indicative of the severity of soft tissue damage to her ankle. It was cold-induced for sure. It was a type of frost bite. It’s not uncommon to see fracture blisters in displaced fractures but in her case it was more of an injury from exposure to the cold.”

“We needed to wait for the soft tissues to heal before we could talk about fixing the broken ankle,” said Scott Ekroth, MD, Physicians’ Clinic of Iowa orthopedic foot and ankle surgeon. “To facilitate healing of the damaged skin we needed to give her ankle some stability.”

It was decided Jeralyn would need two surgeries at St. Luke’s Hospital to fix her injuries. In the first procedure Drs. Munjal and Ekroth placed her ankle in an external fixator, which is a surgical treatment used to stabilize bone and soft tissues.

Collaborative team “We were thankful for this great team of healthcare professionals at St. Luke’s who came together for Jeralyn and devised a plan to get her back on her feet,” said Barbara Westercamp, Jeralyn’s mom.

“The external fixator was used to allow time for the skin to heal around her

Scott Ekroth, MD, Physicians’ Clinic of Iowa orthopedic foot and ankle surgeon Sandeep Munjal, MD, Physicians’ Clinic of Iowa orthopedic surgeon

ankle. It gave us such comfort to know she was well cared for.”

After about four weeks the skin around Jeralyn’s ankle had healed enough to have the second surgery to repair her broken bones.

“The challenge of operating on a fracture that is several weeks old is you have to break up some of the healing that has already occurred and then move the bones where they should be. It takes a bit of work to get things shifted where they needed to be and put the screws and plates in place for the healing process to start over again,” said Dr. Ekroth.

“Jeralyn’s surgery went well and her ankle fracture healed nicely,” said Dr. Munjal.

“Unfortunately there was nerve damage with the break and the recovery has been a bit of a challenge so we’ve worked with a collaborative team of health professionals, which include therapy and physiatry to help her fully recover.”

Excellent care in Cedar Rapids “We felt confident in our choice of St. Luke’s,” said Barbara. “We knew if we had any questions or concerns they had it covered. Everyone from the doctors, nurses, cafeteria workers and housekeepers provided great care. We are fortunate to have such an excellent team right here in Cedar Rapids.”

Today Jeralyn is back for her final year at the University of Iowa where she is pursuing a triple major in management, marketing and political science.

“It has been a long recovery but I am thankful for Drs. Munjal and Ekroth for their exceptional care,” said Jeralyn. “I can’t imagine what might have happened if I didn’t have them and the fabulous team at St. Luke’s to help me get back on my feet.”

To learn more about St. Luke’s services and procedures, visit unitypoint.org/cedarrapids.

St. Luke’s Health Beat | Fall 2013 |

7

New treatment for prostate cancer

H

erb Hoover didn’t think he would live to see 2013. That’s because the 74-year-old Marion man was diagnosed with advanced stage prostate cancer a decade ago.

Aggressive cancer

“I am grateful to still be alive,” said Herb.

“I told my doctors I wanted to stick around long enough to see my grandkids graduate from high school. I’m still planning to do that.”

for prostate-specific antigen. It’s a blood test, which analyzes PSA – a substance naturally produced by a man’s prostate gland. If a higher than normal level is found, it may be an indication of cancer.

Years ago one of Herb’s daughters asked him if he ever had a PSA test. PSA stands

“I put it off,” said Herb. “I wasn’t one to go to doctors. I am a pilot so I would get a physical to maintain my pilot’s license but my PSA level wasn’t something the doctors needed to check for the license. So I let it go. I felt fine and didn’t see a need.”

“Surgery wasn’t an option for Herb because it had already spread to the lymph nodes,” said Thomas Warren, MD, Physicians’ Clinic of Iowa Hematology & Oncology.

“Having surgery at that point – once it has moved beyond the prostate gland won’t stop the spread of the cancer.”

He eventually went to his family doctor and had a PSA test. His results were unexpected and devastating.

“My PSA number was high,” recalled Herb. “Martha and I decided we’d tell our family after our niece’s wedding in Minnesota. It wasn’t easy news to deliver.”

Martha is his wife of over 50 years.

“We looked for the silver lining,” said Martha. “We learned prostate cancer was slow growing. At this point we didn’t know a whole lot about his cancer. It was very early and we kept a positive attitude.”

“The drug mimics calcium and targets the cancer in the bones, which helps ease a patient’s pain and prolongs their life span.”

Thomas Warren, MD Physicians’ Clinic of Iowa Hematology & Oncology

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But the news was anything but positive.

They learned his cancer had already metastasized.

Once prostate cancer has spread to other areas of the body, it may still respond to treatment and may be controlled, but it can no longer be cured.

“I have been treating Herb for a number of years,” said Dr. Warren. “We’ve used hormone treatments that stop the body from producing the male hormone testosterone, which feeds prostate cancer cells. Cutting off the supply of hormones may cause cancer cells to die or grow slower.”

“I have been through lots of treatment in the ten years since my diagnosis,” said Herb.

“Hormone therapy, chemotherapy and all of these things have prolonged my life.”

“He has responded well to all of the treatments longer than doctors thought was possible,” said Martha. “Thankfully he hasn’t had a lot of side effects.”

“He has such a positive attitude and that has served him well,” said Dr. Warren. “He has tolerated a lot of treatments many men are not able to tolerate but they only work for so long. I told Herb about a new treatment recently approved by the FDA.”

Radium 223 The treatment, called Radium 223 (brand name Xofigo) is a newly approved drug that emits radioactive particles, which can extend the lives of certain men with advanced prostate cancer. UnityPoint Health – St. Luke’s Hospital is among the first hospitals in the state to offer this new treatment.

It was approved by the Food and Drug Administration (FDA) in May after a successful clinical trial, and is most appropriate for men with prostate cancer whose disease has spread to the bone but not to other organs.

Radium 223 is injected into the vein and collects in the bone. The radiation kills the cancer cells and reduces the pain men with advanced prostate cancer can experience in their bones.

“Radium 223 is not a cure,” said Dr. Warren. “The drug mimics calcium and targets the cancer in the bones, which helps ease a patient’s pain and prolongs their life span.”

Patients who participated in the clinical trial typically survived for 15 months, versus 11 months among men who received a placebo.

“The survival time may not seem like that much,” said Dr. Warren. “But that’s a 30 percent improvement in survival for men with a rather poor prognosis. In advanced stages the cancer spreads to the bones, which is very painful. This drug allows us to give these men a better quality of life, with fewer side effects than standard prostate cancer treatment, for the time they have left.”

Radium 223 injections pose no harm to others around them. Patients receive one injection per month for six consecutive

Herb Hoover in his work shop at his Marion home.

months. Most insurance companies cover the treatment.

“St. Luke’s Cancer Care is committed to providing our patients with the most upto-date treatments, while still maintaining the high quality care we are known for,” said Kimberly Ivester, St. Luke’s Cancer Care director. “A team of doctors and nurses worked together to bring this new treatment to Cedar Rapids because it is in the best interest of our patients.”

Herb started Radium 223 treatments in August. He and his wife are thankful for the new treatment and the additional time they and their family will continue to enjoy together.

To learn more about Radium 223 and other treatments for prostate cancer, call 319/369-7116.

St. Luke’s Health Beat | Fall 2013 | 9

Choosing UnityPoint

Hospice

A former hospice nurse becomes the patient

T

he day before Peggy Loeffers’ funeral in June a group of nearly 40 of her coworkers, family and friends walked and ran around the Kirkwood Community College track as part of “Team Peggy” in the Relay for Life American Cancer Society fundraiser. It was one week after Peggy, at 63 years old, a UnityPoint Hospice nurse, passed away.

She had been diagnosed with lung cancer in June 2012 – not long after participating in Relay for Life with a team of coworkers. She’d been noticing differences in depth perception between her right and left eyes. Doctors quickly discovered she had a brain tumor.

“They were going to surgically remove the tumor and 15-20 minutes before the surgery they told her through a routine chest X-ray, they found a spot on her lung,” explained Bill Loeffers, Peggy’s husband. The spot turned out to be cancer, which had been the cause of the brain tumor. “She had radiation and chemo, and the cancer moved to her liver and that’s what eventually took her life. From the diagnosis until her death was almost a year. That’s what Dr. Fusselman, her oncologist, told us – that she would have anywhere from eight months to a year,” Bill said.

“Team Pe ggy” Peggy had been a nurse for 42 years, the last seven as a nurse for UnityPoint Hospice. She loved the one-on-one care and the time she could devote to her patients. “Peggy was such an amazing presence,” said Jamie Siela, the social worker on Peggy’s hospice team and a longtime coworker and friend. “You couldn’t walk through a restaurant or a store without someone saying, ‘Peggy!’ She was always talking and really made people feel comfortable. Everybody was a friend to her.”

Transition to hospice It was mid-April as Peggy was finishing a hospitalization and working with UnityPoint Health – St. Luke’s Palliative Care, when she decided to enter hospice care. “She had made up her mind that she was going to do the hospice thing whether I liked it or not,” explained Bill. “It was more difficult for me because I looked at hospice as being the last resort. I figured if she went to hospice that was like giving up.”

“ It was simply a matter of letting Peggy be in charge, and fortunately she was able to be very much in charge. We just had to listen.”

James Bell, MD, St. Luke’s Palliative Care and UnityPoint Hospice medical director

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Many families are reluctant to enter hospice for that reason. “Hospice care is a change in focus but it doesn’t mean you won’t be getting medical attention and interdisciplinary team care,” Siela explained. “We’re still going to be with you along this whole journey, just with a focus on comfort and quality of life rather than on treating or fixing the diagnosis. We want to make every day as good as it can be for our patients.”

“If someone reaches a point where they are comfortable and stable enough that it looks like they will likely survive more than six months, our focus turns to making sure we have a safe and good plan for them going ahead and transition them that way, understanding they may very well come back into hospice at some point,” said James Bell, MD, medical director of UnityPoint Hospice and St. Luke’s Palliative Care.

Quality of care Bill worried Peggy wouldn’t get the quality of care at home she could receive in the hospital. “She talked me into hospice. Dr. Bell came to the hospital room, we sat and discussed it with our daughters and older granddaughters. We reached the conclusion if that’s what she wanted, that’s what we would do. I was glad we did,” Bill said.

Peggy picked the team of coworkers she wanted to care for her. “It was simply a matter of letting Peggy be in charge, and fortunately she was able to be very much in charge. We just had to listen,” said Dr. Bell.

“They took care of everything,” Bill said.

“They got us a bed. She wanted a hospital bed where the head and feet come up. They got us a wheelchair. They had a person come in and tell us what we could do to make it better for her. There was somebody here quite a bit of the time helping out.”

“Even after she passed, hospice has been quite helpful. If I needed some advice on something, I could call and they could tell me what they knew. They’ve just been wonderful.”

For more information about UnityPoint Hospice, go to cedarrapidshospice.com or call 319/369-7744.

Peggy’s team also included a nurse, massage therapist and a chaplain. Bill was her main caregiver and he did an amazing job according to Siela. In the beginning, Peggy was seen weekly by many on the hospice team. Towards the end, it was daily.

“When I called, they’d come over right away. I can’t say enough about that hospice team. I felt like she was being really well cared for,” Bill said.

Bill Loeffers is thankful he and his wife, Peggy, chose UnityPoint Hospice for her end-of-life care.

St. Luke’s Health Beat | Fall 2013 | 11

Ask the

Expert

What are the new advancements for breast cancer?

I

n the last several decades treatment of breast cancer has evolved significantly. More individuals are breast cancer survivors thanks to better diagnosis and treatment options.

“In the early 1980s mammography wasn’t the diagnostic tool it is today,” said Robert Brimmer, MD, Physicians’ Clinic of Iowa general surgeon. “Back then a woman would usually find a lump and undergo a biopsy. If the lump was cancer, she would have a mastectomy. This was all one surgery. She would then wake up without a breast and learn of her breast cancer diagnosis. Thankfully we have come a long way since then.”

Use of newer technology like a needle biopsy allows doctors to use an ultrasound or stereotactic machine to make a breast cancer diagnosis.

“Use of a needle biopsy is a great advancement in breast cancer treatment,” said Dr. Brimmer. “It gives the woman an opportunity to talk with her healthcare team about what the most appropriate care is for her. Does she want a lumpectomy with intraoperative electron radiation therapy (IOERT) or a total mastectomy with reconstructive surgery?”

IOERT allows the traditional radiation using electrons to be given in the operating room (OR) rather than a center. Through an international clinical trial, St. Luke’s is combining breast conservation therapy with radiation in the OR, directly targeting the most common location where breast cancers recur. This radiation boost is equal to five to seven daily radiation treatments.

“This treatment presents an innovative and exciting option for select women and

12 | unitypoint.org/cedarrapids

is part of the evolution of breast cancer care,” said Dr. Brimmer.

“It reduces weeks of radiation treatments. Most patients using IOERT will only need three weeks of radiation therapy after surgery. It’s an option for a woman who wants breast conservation surgery. In most cases she can have the cancer removed, start radiation treatments and have oncoplastic surgery, which uses plastic surgery techniques to reshape the breast all at once.”

Another breakthrough is use of the sentinel lymph node biopsy,

Robert Brimmer, MD Physicians’ Clinic of Iowa general surgeon

Did you know?

St. Luke’s, which is part of the Helen G. Nassif Community Cancer Center, along with Physicians’ Clinic of Iowa recently became the first hospital in Cedar Rapids and one of only five Iowa hospitals to receive full accreditation from the National Accreditation Program for Breast Centers (NAPBC). Accreditation is granted only to those centers that undergo a rigorous evaluation.

which determines if cancer has spread. In years past if cancer spread to the lymph nodes they were surgically removed. A study two years ago called Z11 determined radiation therapy to the breast and lymph nodes (if the cancer had spread there) had virtually the same survival rates as surgical removal of the nodes. St. Luke’s and most other hospitals across the country are using this as best practice for applicable cases.

“Between Physicians’ Clinic of Iowa, St. Luke’s Hospital and the Nassif Community Cancer Center we have the all the tools, technology and options a breast cancer patient would want,” said Dr. Brimmer. “We will care for them and support them in whatever their decision is. It’s a collaborative effort.”

Learn more about the Helen G. Nassif Community Cancer Center at communitycancercenter.org.

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Gayle Zinda is a mom, grammy, former nurse – and survivor of breast and lung cancer. When it comes to receiving lemons – she really knows how to make lemonade! Gayle is an author and travels the world giving inspirational and motivating programs about handling life’s challenges.

Laugh, cry and add the zest back into your life with Gayle.

Tuesday, October 22 • 6:30 p.m.

Did you sleep well?

Millions of Americans struggle with sleep. You know all too well if you have trouble falling asleep, or staying asleep, but would you know if you had sleep apnea? Attend to learn about various sleep disorders, diagnosis, treatment and why quality rest is so important to good health. Dr. Warangkhana Wongba from UnityPoint Clinic leads this discussion.

Tuesday, October 29 • 6:30 p.m.

Cooking with a Cardiologist Learn how to cook simple, delicious and heart healthy meals, with a cardiologist from UnityPoint Clinic – Cardiology.

Dr. Wongba UnityPoint Clinic Multi-Speciality

Wednesday, October 16 Topic: Heart-healthy harvest Wednesday, November 20 Topic: Heart-healthy smart carbs

St. Luke’s

LiveWell events Classes are held at St. Luke’s Hospital, 3rd floor Nassif Heart Center classrooms.

To register for these free events, go to unitypoint.org/cedarrapids, click on Classes and Events or call 319/369-7395.

Wednesday, December 11 Topic: Heart-healthy holiday entertaining All Cooking with a Cardiologist programs are from Noon - 1 p.m. and are located at Physicians’ Clinic of Iowa Medical Pavilion, 3rd floor Community Room, 202 10th St., SE. To register for these free events, call 319/739-2085 or visit cardiology.unitypointclinic.org.

St. Luke’s Health Beat | Fall 2013 | 13

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We apologize for mailing problems such as duplicate copies. If you have questions or concerns about Health Beat magazine, please call us at 319/369-7395 or e-mail StLukesCR@unitypoint.org.

1026 A Avenue NE P.O. Box 3026 Cedar Rapids, IA 52406-3026

© 2013 St. Luke’s Hospital, Cedar Rapids, IA

Lyz

Kate

Chicken nugget aficionado

Accessory queen

Ashley

Mel

Kendra

Teacher and military wife

Knitter extraordinaire

Pink Harley chic

Real moms. Real stories.

An interactive blog for moms and moms-to-be.

Visit therealmomsofeasterniowa.com.

T

hese ladies don’t hold back. They focus on the trials, tribulations and triumphs of being a parent. Discussion topics include everything from learning you’re expecting to sleepless nights and all the moments in between. St. Luke’s invites you to join the conversation by sharing your “Real Mom” stories, exchanging information and providing support to each other all in one spot – therealmomsofeasterniowa.com.

We hope to see you there!